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Modified TNM staging system for well-differentiated pancreatic neuroendocrine tumors: A comparative study with the
Min Yang1, Jie-Yu Wen1, Gui-Zhen Qian2
1Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, the People's Republic of China.
Background:
Continuing to use the 8th edition criteria, the current American Joint Committee on Cancer (AJCC) 9th staging system has been demonstrated to fail to distinguish prognosis in Stage I between Stage II for patients with G1/G2 pancreatic neuroendocrine tumors (p-NETs). A modified tumor-node-metastasis (mTNM) system with revised nodal classification was previously proposed, but hasn't been comprehensively validated by large-scale institutional studies.
Methods:
Data of eligible patients was retrospectively collected and distributed by the proposed mTNM staging system and the current AJCC 9th staging system. The staging characteristics for G1/G2/G3 p-NETs were respectively performed and compared by two systems.
Results:
Our study enrolled 310 patients with well-differentiated p-NETs, including 122 ones with G1, 132 with G2 and 56 with G3. The 5-year overall survival (OS) from AJCC Stage I to Stage IV was respectively 79.0 %, 88.8 %, 39.5 % and 15.8 %, in which survival comparison between Stage I and Stage II wasn't significant (P = 0.114). The OS at 5 years from mTNM Stage I to Stage IV was respectively 93.4 %, 75.5 %, 34.1 % and 15.8 %, in which notable survival differences were offered among each stage (P < 0.05). Moreover, consistent with the results of Akaike information criteria and Harrell's concordance index, the 95 % confidence intervals in multivariate analysis for proposed mTNM staging system were smaller than that of AJCC 9th staging system, indicating a more accurate predictive ability for the OS of G1/G2/G3 p-NETs.
Conclusion:
The proposed mTNM staging system was superior to the current AJCC 9th system for well-differentiated p-NETs.
